Friedewald Formula Research Articles

METABOLIC SYNDROME IN FEMALE WORKERS FROM A TEXTILE MILL: EFFECT OF NOISE

Objective: Noise creates alteration in human health in both physical as well as psychological variations. Effect of noise on components of metabolic syndrome (MetS) has been discussed but not well established. The aim of this study was to investigate the MetS in female workers from textile mill.Methods: A total of 65 female workers were recruited for the study from the high noise (>70 dB) area and low noise (<40 dB) area of a textile mill. Body mass index (BMI), blood pressure (BP), blood sugar (BS), and lipid profile were investigated of the female workers. BP was estimated by auscultatory method. BS was investigated by glucose oxidase-peroxidase (POD) method. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were investigated by cholesterol oxidase (CHOD)-POD method, GPO- PAP method, CHOD-POD/phosphotungustate method, and friedewald formula, respectively.Results: Significant outcomes were obtained in this study. BMI was significantly (<0.01) higher in workers working in high noise area compared to low noise (<40 dB) area. Systolic BP and diastolic BP was also significantly (<0.01) higher in high noise area. Fasting BS level was found to be significantly (<0.01) lower in low noise area. In case of lipid profile significant (<0.01) results were obtained except LDL-C. TC and TG were found to be related with noise since their concentration was higher in high noise area compared to low noise area. However, HDL-C was found to be lower in high noise area compared to low noise area.Conclusion: Continuous exposure to occupational noise might be reason for developing cardiovascular disease depending on the degree of MetS in industrial workers. BP and BS seems to be better predictor of MetS in assessing cardiovascular risk.Keywords: Occupational noise, Metabolic syndrome, Dyslipidemia.

Correlation of Friedewald's calculated low-density lipoprotein cholesterol levels with direct low-density lipoprotein cholesterol levels in a tertiary care hospital.

Background:One of the risk factors for the development of coronary heart disease is high low-density lipoprotein (LDL) cholesterol levels. National Cholesterol Education Program ATP III guidelines suggest drug therapy to be considered at LDL-cholesterol levels >130 mg/dl. This makes accurate reporting of LDL cholesterol crucial in the management of Coronary heart disease. Estimation of LDL cholesterol by direct LDL method is accurate, but it is expensive. Hence, We compared Friedewald's calculated LDL values with direct LDL values.Aim:To evaluate the correlation of Friedewalds calculated LDL with direct LDL method.Materials and Methods:We compared LDL cholesterol measured by Friedewald's formula with direct LDL method in 248 samples between the age group of 20–70 years. Paired t-test was used to test the difference in LDL concentration obtained by a direct method and Friedewald's formula. The level of significance was taken as P < 0.05. Pearsons correlation formula was used to test the correlation between direct LDL values with Friedewald's formula.Results:There was no significant difference between the direct LDL values when compared to calculated LDL by Friedewalds formula (P = 0.140). Pearson correlation showed there exists good correlation between direct LDL versus Friedewalds formula (correlation coefficient = 0.98). The correlation between direct LDL versus Friedewalds calculated LDL was best at triglycerides values between 101 and 200 mg/dl.Conclusion:This study indicates calculated LDL by Friedewalds equation can be used instead of direct LDL in patients who cannot afford direct LDL method.

Comparison of Different estimated Formulas with Direct Estimation of Low-density Lipoprotein Cholesterol

ABSTRACT Introduction Recent recommendations of the Adult Treatment Panel and the Adolescents Treatment Panel of the National Cholesterol Education Program make the low-density lipoprotein cholesterol (LDL-C) levels in serum the basis of classification and management of hypercholesterolemia. This makes accurate reporting of LDL-C decisive in the management of coronary heart disease (CHD). Direct measurement of LDL by homogeneous method is accurate but reagent is costly. Therefore, we have to compare different calculated LDL values with direct LDL (D-LDL) values. Aim The aim of this study was (1) to decide if LDL-C level was underestimated/overestimated after it was calculated using the formulae compared with direct measurement of LDL-C and (2) to choose the best calculated method that compares maximum with the direct method. Materials and methods We measured total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), D-LDL by direct homogeneous method in 500 fasting samples. Simultaneously, Friedewald's (F-LDL-C), modified Friedewald's (MF-LDL-C), and Anandaraja's (A-LDL-C) formulas were also used for calculation of LDL-C. Results A good correlation was found between D-LDL-C as compared with F-LDL-C, MF-LDL-C, and A-LDL-C. Pearson's coefficient of correlation between MF-LDL-C and D-LDL-C was 0.94, which was moderately higher than other calculated methods. Pearson's coefficient of correlation between A-LDL-C and D-LDL-C was 0.92 and F-LDL-C and D-LDL was 0.93. Conclusion In conclusion, among the three LDL-C formulas, the Friedewald formula and Anandaraja' s formulas give a higher percentage of error compared with the modified Friedewald formula Therefore, modified Friedewald's formula is better than the other two formulae for calculating LDL-C in a more cost-effective manner and can be used in large population studies. How to cite this article Kanani DN, Mishra A. Comparison of Different Estimated Formulas with Direct Estimation of Low-density Lipoprotein Cholesterol. Indian J Med Biochem 2017;21(2):151-156.

Homogeneous Assays for LDL-C and HDL-C are Reliable in Both the Postprandial and Fasting State.

Aim: Most epidemiological and clinical studies calculated low-density lipoprotein-cholesterol (LDL-C) by Friedewald's formula which cannot be used in the postprandial samples. Although the homogeneous assays with poor analytical performance were withdrawn from the market, it remained unclear whether the currently available reagents for LDL-C and high-density lipoprotein-cholesterol (HDL-C) are as accurate for postprandial samples as for fasting samples.Methods: Fresh blood samples were collected from 59 non-diseased and 109 diseased subjects. Postprandial samples constituted 72.9% and 39.4% of these samples. LDL-C and HDL-C concentrations were measured using the homogeneous assays of four manufacturers (Denka Seiken, Wako, Kyowa Medex, and Sekisui Medical). Simultaneously, LDL-C and HDL-C concentrations were determined using the reference measurement procedures (RMPs) of the Centers for Disease Control and Prevention (CDC). Total errors were calculated using a routine method (TEcom) and via error component analysis (TEeca).Results: All homogeneous assays for LDL-C and HDL-C met the National Cholesterol Education Program (NCEP) requirements in terms of coefficient of variation, and TEcom in both non-diseased and diseased subjects. LDL-C and HDL-C values measured by the homogeneous assays were in good agreement with those measured by the RMPs in both fasting and postprandial samples. The TEcom and TEeca values of the postprandial samples were similar to those of fasting samples, although the TEeca values were up to 4.4-fold greater than the TEcom values.Conclusions: In both non-diseased and diseased subjects, the homogeneous assays for LDL-C and HDL-C of four manufacturers are as accurate for postprandial samples as for fasting samples.

Accuracy of Non-Fasting Lipid Profile for the Assessment of Lipoprotein Coronary Risk.

To determine the diagnostic accuracy of non-fasting lipid profile in the diagnosis of hyperlipidemia, taking fasting lipid profile as gold standard, in adult population. Cross-sectional validation study. Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from July to December 2014. One hundred seventy-five adult patients coming for fasting lipid profile were included; their non-fasting samples were taken on the next day. Patients on anti-cholesterol treatment and indoor patients were excluded. Total cholesterol (TC), high density lipoprotein-cholestrol (HDL-C), and triglycerides were measured by direct enzymatic colorimetric method by Modular p-800®. Low density lipoprotein-cholesterol (LDL-C) was calculated by Friedewald's formula, but when triglyceride was greater than 4.5 mmol/l, then LDL-C was measured directly by homogenous enzymatic colorimetric method. Non-HDL-C was calculated by simple equation, i.e. TC-HDL-C. Non-fasting lipid profile had 93% specificity , 51% sensitivity, 94% positive predictive value and 49% negative predictive value; and 65% accuracy with 7.28 positive likelihood ratio and 0.52 negative likelihood ratio. Non-fasting TC and non-HDL-C were significantly higher than fasting TC and non-HDL-C by mean difference of 0.2 mmol/l each with p=0.001 and p=0.004, respectively. Fasting and non fasting HDL-C are comparable to each other with mean difference of 0.01 mmol/l (p=0.745). Receiver operating curve (ROC) of non-fasting non-HDL-C showed 0.804 (95%CI (0.738-0.870), (p=0.000) area under the curve (AUC) indicating that it was a significant test for ruling out hyperlipidemia. Bland-Altmann plot showed a significant difference between non-fasting, non-HDL-C and fasting LDL-C and non-fasting, non-HDL-C -0.087540 with bias -0.00109; therefore, these cannot be alternative to each other. Diagnostic accuracy of non-fasting lipid profile was found significantly higher than fasting lipid profile (p=0.004) for the assessment of lipoprotein coronary risk on the basis of non-HDL-C, which seemed to be significant test for ruling out hyperlipidemia.

Hematologic, Plasma Biochemical, and Lipid Panel Reference Intervals in Orange-winged Amazon Parrots ( Amazona amazonica ).

To establish reference intervals in orange-winged Amazon parrots ( Amazona amazonica ) for the complete blood count, plasma biochemical values, and lipid panel and to evaluate age- and sex-related variations, blood samples were obtained from 29 healthy juvenile and adult parrots. Concentrations of total protein, bile acids, phosphorus, total cholesterol, low-density-lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol were significantly higher in adult compared with juvenile birds, while uric acid concentration was significantly higher in juveniles. The white blood cell count, lymphocyte count, and phosphorus and potassium concentrations were significantly higher in females, while chloride concentration was significantly higher in males. In this species, direct measurement of LDL-C resulted in lower concentrations than LDL-C calculated with the Friedewald formula. Assessment of the agreement between the calculated and measured LDL-C concentrations indicated a systematic bias of 19.1 mg/dL and a proportional bias of 1.07. A correction factor of -19 mg/L could be applied to the Friedewald formula, to obtain a result closer to the measured LDL-C, providing clinically acceptable (<20% difference) agreement in 66% of the samples. Triglyceride concentrations within the range measured in healthy birds of the present study did not significantly affect the bias between calculated and directly measured LDL-C. Further studies are needed to investigate the impact of nutritional factors, genetics, and exercise on biochemistry and lipoprotein panel analytes in orange-winged Amazon parrots.

ATHEROGENIC PARAMETERS AND CARDIAC INDICES IN PROGNOSTICATION OF DEVELOPMENT OF PRE-ECLAMPSIA AND ITS CARDIOMETABOLIC CONSEQUENCES

Aim of the work. The study of interconnection between atherogenic parameters of the blood serum and cardiac indices during pregnancy with the risk of pre-eclampsia development and prognostication of remote cardio-vascular and/or metabolic pathology among pregnant. Materials and methods. The indices of lipid metabolism in the blood serum of 267 pregnant women were studied using diagnostic sets of reagents. The blood sampling was carried out in II (16-24 gestational weeks) trimester. The general cholesterol (GC) and triglycerides (TG) were determined by colorimetric and enzymatic method; high-density lipoproteins – HDL – by homogenous method of direct determination of HDL-cholesterol concentration in the blood serum without preliminary processing and centrifugation, low-density lipoproteins – LDL – by the direct method. VLDL concentration was calculated by Friedewald formula: LDL = TG/2,2. For evaluation of GC-VLDL concentration TG/2,2 parameter is used, if TG concentration is expressed in mmol/l (or TG/5, if concentration is expressed in mg/100 ml). Cardiac indices were calculated taking into account the lipid parameters according to the correspondent mathematical formulas. Lactate and LDH concentrations were determined by optimized method using diagnostic reagents. Lactate concentration was determined at the use of diagnostic set for determination of lactate concentration, and DLH was also determined by diagnostic set for determination of LDH (DL) activity by optimized method, elaborated taking into account the recommendations of German Association of clinical chemistry (DGKC) after correspondent calibration of automatic analyzer ACCENT-200 II GEN. Depending on the development of clinical presentation of PE 43 women were divided in groups with light and middle severity of course of this pathology. Results and discussion. Among the women with PE development was observed the essential changes in II trimester in the aspect of atherogenic parameters and cardiac indices mainly at the expense of progressing increase of TG in the blood serum (mmol/l: I group - 1,73 ± 0,14, II group - 1,86 ± 0,18 comparing with III control group - 1,51 ± 0,06. The gradual growth of cardiac (atherogenic) indices - AIP, CR and CА and connection between AIP and the levels of maternal serumal TG and arterial pressure were observed in women with PE development at the absence of such connection among the women of control group (p &lt;0,05) . LDH level grew with the progressing of PE severity: for the women of I group LDH level was - 389 ± 1,6 U/l at 778 ± 0,25 in women of II group and 265 ± 0,19 in the control group (p &lt;0,05). Conclusions. It was demonstrated, that hypertriglyceridemia at pregnancy is a predicator relative to PE development and together with progressive growth of atherogenic indices can be considered as prognostic factor for cardiometabolic pathology, especially in women with undergone severe forms of this pathology. It was established, that the increase of LDH level since the second trimester can also testify to the development of PE and remote cardiac pathology in this category of women.

Comparing calculated LDL-C with directly measured LDL-C in healthy and in dyslipidemic children

BackgroundLDL-C is one of the strongest markers for atherosclerosis and therapeutic decisions in children are based on its levels. Friedewald formula (FF) which is usually used for the calculation of LDL-C (cLDL-C); and Anandaraja's formula (AF) may under- or overestimate actual levels. ObjectiveTo compare cLDL-C with directly measured LDL-C (dLDL-C) as a screening tool and to evaluate dyslipidemic children. MethodsThe study population consisted of 1005 children, 2–18years, 688 of whom underwent lipid screening in a regular check-up (group A); and 317 were dyslipidemic (LDL-C ≥130mg/dl) (group B). A fasting serum lipid profile was assessed. LDL-C was measured using a homogenous assay and was calculated using FF and AF. ResultsEach method of calculating LDL-C was highly correlated to dLDL-C. Using FF, cLDL-C was lower than dLDL-C in 75.6% (group A) and in 77.3% (group B) of children; the mean difference was significant in dyslipidemic group. Moreover, in group B, 25% of children with boundary high and 12% with high dLDL-C would be misclassified. Using AF, LDL-C was higher than dLDL-C; the mean difference was significant in group A. Based on cLDL-C, 52% of group A with borderline dLDL-C and 27.5% of group B children with boundary high dLDL-C would be considered as dyslipidemic and eligible for medication respectively. ConclusionsComparing two methods of calculated LDL-C with directly measured LDL-C. FF was more accurate as a screening tool while AF was more accurate in the evaluation and follow-up of the dyslipidemic group.

Comparison of LDL - cholesterol estimated by direct method and by calculation

Introduction: Total cholesterol (TC) and Low-density lipoprotein cholesterol (LDL-C) are well-established risk factors for the coronary heart disease (CHD). There are many homogenous assays currently available for the estimation of serum LDL-C. Most clinical laboratories determine LDL-C (mg/dL) by Friedewalds formula (FF), LDL-C = (TC) - (HDL-C) - (TAG/5). This formula shows the level of LDL-C is dependent on triglyceride (TAG) level. Aim and Objectives: The aim of this study was to find out the relative advantages of direct measurement of cholesterol over the conventional derivation of LDL-C by calculation. Material and Method: The study contained 80 participants above 18 years. LDL-C estimation was done by direct method manually on the spectrophotometer and also calculated using the Friedewalds Formula. An independent t-test was applied to find out the statistically significant difference. Results: It was observed that, the mean LDL-C levels by calculated method and the direct method in the control group (TAG?150 mg/dl) (114.83 and 116.88 mg/dl respectively, P=0.81), case group-1 (TAG=150-300 mg/dl) (113.11and 116.01 mg/dl respectively, P=0.82) and case group-2 (TAG=300-400 mg/dl) (112.75and 116.30 mg/dl respectively, P=0.73) show no significant difference, but in the case group-3 (TAG?400 mg/dl) (112.12 and 182.0 mg/dl respectively, P<0.001) shows significant difference. Conclusion: Our data suggest that; the estimated LDL-C can be substantially underestimated due to the high triglyceride levels of 400 mg/dl or more. These results in the misclassification of the risk, where the patients calculated LDL-C may be lower than their true LDL-C, resulting in the missed opportunities for the treatment.

Study of serum lipid profile in subclinical hypothyroidism

Objective: It has been known that overt hypothyroidism is associated with hyperlipidemia, replacement therapy with Levothyroxine significantly reverses lipid metabolism abnormalities. But no clear consensus has been established regarding the treatment of Subclinical Hypothyroidism subjects. This is due to the fact that there are no data from large trials on whether and to what degree Subclinical Hypothyroidism affects lipid profile. This study is aimed to provide a look at the status of Lipid Profile in the case of Subclinical Hypothyroidism. Materials and Methods: Total 100 subjects were recruited and divided into 2 groups. 50 Patients with Subclinical Hypothyroidism were considered as the cases and 50 healthy people as the controls. Serum TSH was analysed by sandwich electrochemiluminescence immunoassay method. Serum cholesterol, triglyceride and HDL were estimated by enzymatic colorimetric method, LDL was calculated by using friedewald formula. Results: Serum cholesterol, LDL were higher (P<0.0001) and HDL (P<0.0001) was lower in Subclinical Hypothyroid patients (meanSD= 199.927.8 mg/dl, 130.026.3mg/dl, 44.29.1 mg/dl respectively) compared to healthy controls (meanSD= 170.116.8 mg/dl, 97.314.7 mg/dl, 54.210.0 mg/dl respectively). A significant correlation was found between the levels of TSH and Serum Cholesterol (r=0.5101, P<0.0001), LDL (r=0.5637, P<0.0001) and a significant negative correlation was found between the levels of TSH and HDL (r=-0.4525, P<0.0001). Conclusion: Subclinical hypothyroidism is associated with elevated levels of Serum Total Cholesterol and LDL which is atherogenic in nature, and low level of HDL. This may further increase the risk of development of atherosclerosis.

Clinical Significance of Low Density Lipoprotein Cholesterol Measurements: Direct Versus Indirect Method

Introduction: Estimation of low density lipoprotein cholesterol (LDL-C) is crucial in management of coronary artery disease patients. The management of dyslipidemia is largely based on the concentration of LDL-C. The objective of this study was to compare direct measurement of LDL-C determined by a homogenous method with LDL-C estimation done by Friedewald formula (FF) in heterogeneous populations. Methods: In this cross sectional study, we measured LDL-C by homogenous method (D-LDL-C) in 1,000 fasting samples &amp; compared with FF (F–LDL-C) used for calculation of LDL-C. The measurements of total cholesterol (TC) and triglycerides (TG) were performed using traditional enzymatic methods. The measurements of high density lipoprotein cholesterol (HDL-C) and LDL-C were performed using direct methods with precipitation, and the estimation of the LDL-C fraction was calculated using the FF. Results: Correlation analysis shows that the two methods had significant correlation (p&lt;0.0001). However the FF had positive bias in regard to direct method with TG levels ≤150 mg/dL. No bias was observed between the methods for TG levels from 151-200 mg/dL &amp; from 201-300 mg/dL. Whereas, TG levels from 301-400 mg/dL shows negative bias by FF. Conclusion: The Friedewald’s formula does not shows homogenous performance for estimating LDL-C levels in samples with different TG levels as compared with that of direct method.

A Correlative Study of Serum Homocysteine with Serum Lipid Profile in Young Adult Hypertensive Patients in Indian Population

Background: Hypertension and dyslipidemia are major risk factors for cardiovascular disease (CVD) and a leading cause of morbidity and mortality in both developed and developing countries. The prevalence of hypertension is projected to increase globally, especially in the developing countries. In recent years, rapid urbanization, unhealthy diet and lifestyle changes have led to an increased rate of CVD. Hyperhomocysteinemia (HHcy) has been regarded as a new risk factor related to hypertension. An elevated homocysteine level induces thrombogenicity, causes procoagulant state and promotes the proliferation of smooth muscle cells, which could lead to vascular constriction and stiffness. Our study was aimed to find out the status of serum homocysteine and serum lipid profile in hypertensive and normo- tensive subjects & correlation of serum homocysteine with serum lipid profile in hypertensive subjects. This study was limited and this topic needs to be further worked upon. Materials and Methods: The present study was conducted on 100 patients with essential hypertension who attended the medical OPD of Jawahar Lal Nehru Medical College and Associated Group of Hospital, Ajmer. The results of patients were compared with 50 normotensive subjects. Anthropometric para- meters and biochemical estimation were performed after taking approval from Ethical Committee. The serum total cholesterol (TC), triglyceride (TG) and HDL cholesterol (HDLC) were determined enzymatically, while LDL cholesterol (LDLC) was calculated using the Friedewald formula & serum homocysteine was determined by ELISA technique. Results: The mean serum level of homocysteine was elevated in hypertensive subjects as compared to normotensive subjects and was highly significant (P<0.0001). The mean values of serum TC, TG and LDL-C were significantly higher and statistically significant among the hypertensive patients compared to normotensive subjects & the mean HDL –C level was lower in the hypertensive subjects compared to normotensive subjects and was statistically significant. The present study has also shown the positive correlation between serum homocysteine and serum TC, TG and LDL-C & negative correlation between serum homocysteine and HDL-C in hypertensive subjects. Conclusion: The observations of this study have revealed that there was significant alteration of serum homocysteine, cholesterol, triglyceride, HDL cholesterol and LDL cholesterol in hypertensive patients. Therefore, for routine monitoring of hypertensive patients to prevent the coronary heart disease (CHD) and other consequences, the reinforcement of these parameters may be recommended in daily clinical practice.

Effect of Fenugreek Seeds Powder (Trigonella foenum-graecum L.) on Experimental Induced Hyperlipidemia in Rabbits

ABSTRACTIn the present experimental study, the effect of Trigonella foenum-graecum L. (TFG) seeds powder on experimentally induced hyperlipidemia in rabbits was investigated. Twenty albino rabbits were randomly, equally divided into two groups and fed pure cholesterol (0.5g/kg body weight/day) for the period of eight weeks to develop hyperlipidemia. Group-I (control) and Group-II received a normal diet with 2 mL normal saline and 2 mL aqueous emulsified TFG seeds powder (500 mg/kg body weight/day) for four weeks, respectively. Lipid profile and weight were measured at baseline after eight weeks and at the end of the study (12 weeks). Atherogenic indices were calculated by Friedewalds formula. Statistical analysis was performed using IBM: SPSS version 20, and student t test was used to compare variables between groups. After eight weeks of study period, cholesterol feeding was discontinued and hyperlipidemic value was compared with the initial baseline data. Significant increase in body weight and lipid profile variables were observed in the two groups, while there was a significant decrease in high-density lipoprotein cholesterol (HDL-C). After the end of the study (12 weeks), the aqueous emulsified fenugreek (TFG) seeds powder reduced significantly the serum total cholesterol, low-density lipoprotein cholesterol (LDL-C), and the atheriogenic index (P < 0.001), with significant increase in the HDL-C (P < 0.001) in experimentally hyperlipidemic rabbits (P < 0.001) as compared to control group, whereas no significant differences were observed in the triglyceride very low-density lipoprotein cholesterol (VLDL-C) and body weight (P > 0.05) of both groups. It was concluded that fenugreek seeds powder had a significant hypolipidemic effect in experimentally-induced hyperlipidemic rabbits.

Validation of the Martin Method for Estimating Low-Density Lipoprotein Cholesterol Levels in Korean Adults: Findings from the Korea National Health and Nutrition Examination Survey, 2009-2011.

Despite the importance of accurate assessment for low-density lipoprotein cholesterol (LDL-C), the Friedewald formula has primarily been used as a cost-effective method to estimate LDL-C when triglycerides are less than 400 mg/dL. In a recent study, an alternative to the formula was proposed to improve estimation of LDL-C. We evaluated the performance of the novel method versus the Friedewald formula using a sample of 5,642 Korean adults with LDL-C measured by an enzymatic homogeneous assay (LDL-CD). Friedewald LDL-C (LDL-CF) was estimated using a fixed factor of 5 for the ratio of triglycerides to very-low-density lipoprotein cholesterol (TG:VLDL-C ratio). However, the novel LDL-C (LDL-CN) estimates were calculated using the N-strata-specific median TG:VLDL-C ratios, LDL-C5 and LDL-C25 from respective ratios derived from our data set, and LDL-C180 from the 180-cell table reported by the original study. Compared with LDL-CF, each LDL-CN estimate exhibited a significantly higher overall concordance in the NCEP-ATP III guideline classification with LDL-CD (p< 0.001 for each comparison). Overall concordance was 78.2% for LDL-CF, 81.6% for LDL-C5, 82.3% for LDL-C25, and 82.0% for LDL-C180. Compared to LDL-C5, LDL-C25 significantly but slightly improved overall concordance (p = 0.008). LDL-C25 and LDL-C180 provided almost the same overall concordance; however, LDL-C180 achieved superior improvement in classifying LDL-C < 70 mg/dL compared to the other estimates. In subjects with triglycerides of 200 to 399 mg/dL, each LDL-CN estimate showed a significantly higher concordance than that of LDL-CF (p< 0.001 for each comparison). The novel method offers a significant improvement in LDL-C estimation when compared with the Friedewald formula. However, it requires further modification and validation considering the racial differences as well as the specific character of the applied measuring method.

Relationship between measurements of non-HDL-cholesterol and LDL-cholesterol in Familial Hypercholesterolaemia

Familial Hypercholesterolaemia (FH) is a monogenic disorder of Low Density Lipoprotein (LDL) metabolism which can be specifically diagnosed by genetic testing. However LDL-cholesterol (LDL-C) estimation has the drawback that it requires a fasting sample, because the Friedewald formula uses a factor relating to fasting triglyceride. Also other cholesterol containing lipoproteins are atherogenic and should be considered as part of cardiovascular risk assessment. Recent guidelines from National Institute for Health and Care Excellence (NICE) recommend non-HDL cholesterol (non HDL-C) for assessment of cardiovascular risk.

Comparison of Formulas for Calculating Low-density Lipoprotein Cholesterol in General Population and High-risk Patients with Cardiovascular Disease.

Background and ObjectivesLow-density lipoprotein cholesterol (LDL-C), an established cardiovascular risk factor, can be generally determined by calculation from total cholesterol, high-density lipoprotein cholesterol, and triglyceride concentrations. The aim of this study was to compare LDL-C estimations using various formulas with directly measured LDL-C in a community-based group and hospital-based group among the Korean population.Subjects and MethodsA total of 1498 participants were classified into four groups according to triglyceride concentrations as follows: <100, 100–199, 200–299, and ≥300 mg/dL. LDL-C was calculated using the Friedewald, Chen, Vujovic, Hattori, de Cordova, and Anandaraja formulas and directly measured using a homogenous enzymatic method. Pearson's correlation coefficients, intraclass correlation coefficients (ICC), Passing & Bablok regression, and Bland-Altman plots were used to evaluate the performance of six formulas.ResultsThe Friedewald formula had the highest accuracy (ICC=0.977; 95% confidence interval 0.974-0.979) of all the triglyceride ranges, while the Vujovic formula had the highest accuracy (ICC=0.876; 98.75% confidence interval 0.668–0.951) in people with triglycerides ≥300 mg/dL. The mean difference was the lowest for the Friedewald formula (0.5 mg/dL) and the percentage error was the lowest for the Vujovic formula (30.2%). However, underestimation of the LDL-C formulas increased with triglyceride concentrations.ConclusionThe accuracy of the LDL-C formulas varied considerably with differences in triglyceride concentrations. The Friedewald formula outperformed other formulas for estimating LDL-C against a direct measurement and the Vujovic formula was suitable for hypertriglyceridemic samples; it could be used as an alternative cost-effective tool to measure LDL-C when the direct measurement cannot be afforded.

Metabolic Status of Lean, Overweight, and Obese Type 2 Diabetes Mellitus Patients

ABSTRACT Aims To compare metabolic status of lean vs overweight/ obese type 2 diabetes mellitus (T2DM) patients and correlate biochemical parameters with anthropometric measures. Materials and methods A total of 100 T2DM patients were categorized as lean and overweight/obese according to body mass index (BMI); 50 age- and sex-matched healthy controls were selected. Anthropometric measures of BMI, waist circumference (WC), and waist:hip (W:H) were recorded. Fasting blood samples were assayed for fasting plasma glucose (FPG), serum total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), and nonesterified free fatty acids (NEFA). Low-density lipoprotein (LDL) was calculated by Friedewald's formula and TG: HDL was measured as measure of insulin resistance (IR). Results Anthropometric measures of overall (BMI 31.65 ± 5.49, 20.34 ± 2.45 vs 22.29 ± 3.21) and visceral adiposity (WC 91.98 ± 6.8, 75.45 ± 4.34 vs 74.19 ± 3.98 and W:H 0.99 ± 0.12, 0.78 ± 0.21 vs 0.76 ± 0.32) were significantly higher in overweight/ obese (p &lt; 0.05) compared with lean T2DM and controls. Total cholesterol, TG, LDL, and NEFA were significantly raised and HDL decreased in T2DM compared with those of controls. But much higher values were observed in overweight/obese than in lean group. Triglycerides: HDL was significantly higher in obese than in lean patients (4.66 ± 1.89 vs 7.91 ± 3.01), confirming significantly decreased insulin sensitivity among obese than non-obese diabetics. Positive correlation was observed between BMI, WC, W:H and TC, TG, LDL, NEFA, and TG:HDL, while negative correlation was observed with HDL in obese group. Lean individuals with normal BMI, WC had deranged lipids with IR. Conclusion Lean and obese T2DM have dyslipidemia and IR. Poor metabolic profile is associated with overall and visceral adiposity in obese and not in lean T2DM individuals. How to cite this article Asegaonkar SB, Kareem I, Aghade S, Pagdhune A, Thorat A, Borkar MS. Metabolic Status of Lean, Overweight, and Obese Type 2 Diabetes Mellitus Patients. Indian J Med Biochem 2016;20(1):6-10.

Chronic consumption of conventional and saturated-fat reduced dairy products have differential effects on low-density lipoprotein cholesterol levels in adults at moderate cardiovascular disease risk

Reducing the intake of dietary saturated fatty acids (SFA) to ⩽10 % of total energy intake is a key public health strategy aimed at lowering current cardiovascular disease (CVD) incidence. Consumption of dairy products (including butter) represents approximately 35 % of total dietary SFA intake(1). Supplementation of the bovine diet with oleic acid-rich plant oil has been reported to depress SFA and increase cis-monounsaturated fatty acids levels in milk, providing a strategy to lower total dietary SFA intake (2). This human intervention study aimed to investigate whether consumption of SFA-reduced, compared with conventional dairy products, would impact on the fasting lipid profile, glucose and insulin concentrations of adults at moderate CVD risk. Fifty-four adults (mean age 53 (SD 13) years, BMI 26 (SD 3) kg/m2), completed a double blind, randomised, controlled 12-week cross-over study with an 8-week washout period between treatment arms. Participants replaced habitual dairy foods/snacks with SFA-reduced or conventional UHT milk, Cheddar cheese and butter (fatty acid (FA) composition of SFA-reduced vs. conventional dairy products: total SFA: -7·0 g/d, C18:1cis: 3·0 g/d, C18:1trans: 2·4 g/d), achieving an isoenergetic daily dietary exchange (41 g/d total fat). At the beginning and end of each treatment period, fasting blood samples were collected for biochemical analysis. LDL-C was estimated using the Friedewald formula. The homeostatic model assessment of insulin resistance (HOMA-IR) was calculated using the glucose and insulin data.

Non-HDL Cholesterol is a More Superior Predictor of Small-Dense LDL Cholesterol than LDL Cholesterol in Japanese Subjects with TG Levels ＜400 mg/dL.

Aim: The Japan Atherosclerosis Society (JAS) guidelines for the diagnosis and treatment of hyperlipidemia in Japanese adults recommend using low-density lipoprotein cholesterol (LDL-C) calculated by Friedewald formula (F_LDL-C) for subjects with triglyceride (TG) levels <400 mg/dL and non-high-density lipoprotein cholesterol (non-HDL-C) levels for subjects with TG levels ≥400 mg/dL. Because small-dense LDL particles are more atherogenic than large LDL particles, we sought the better lipid parameter which was more reflective of the high small-dense LDL-C (sdLDL-C) levels in subjects with TG levels <400 mg/dL.Methods: This study included 769 Japanese subjects who met our inclusion criteria and underwent an annual health examination, including sdLDL-C analyses.Results: The correlation coefficient of non-HDL-C for sdLDL-C (r = 0.760) was significantly higher than that of F_LDL-C (r = 0.601). The area under the curve (95% confidence interval) was 0.771 (0.731, 0.811) for F_LDL-C and 0.871 (0.842, 0.901) for non HDL-C, which showed significantly higher predictive value for more than fourth quartile value of sdLDL-C (46 mg/dL). The optimal cut-off point of non-HDL-C was 158 mg/dL. Even in subjects stratified by waist circumstance, homeostasis model assessment of insulin resistance, TG, and F_LDL-C levels and non-HDL-C showed stronger relationships with sdLDL-C than F_LDL-C. Moreover, non-HDL-C showed a better relationship with sdLDL-C than total cholesterol (TC), TC/HDL-C, and non-HDL-C/HDL-C.Conclusion: Our data suggested that non-HDL-C is superior to F_LDL-C and one of the reliable surrogate lipid markers of sdLDL-C in Japanese subjects with TG levels <400 mg/dL.

Validity of a Novel Method for Estimation of Low-Density Lipoprotein Cholesterol Levels in Diabetic Patients.

Aim: Low-density lipoprotein cholesterol (LDL-C) is routinely estimated using the Friedewald equation [LDL-C(F)]. A novel method for LDL-C [LDL-C(M)] estimation recently proposed by Martin et al. was reported to be more accurate than the Friedewald formula in subjects in the United States. The validity of LDL-C(M) in different races and patients with diabetes mellitus (DM) has not been elucidated. The purpose of this study was to validate the LDL-C(M) estimates in Japanese population with type 2 DM by comparing with LDL-C(F) and directly measured LDL-C [LDL-C(D)].Methods: Both LDL-C(M) and LDL-C(F) levels were compared against LDL-C(D) measured by selective solubilization method in 1,828 Japanese patients with type 2 DM.Results: On linear regression analysis, LDL-C(M) showed a stronger correlation than that shown by LDL-C(F) (R = 0.979 vs. R = 0.953, respectively) with LDL-C(D). We further analyzed the effect of serum triglyceride (TG) concentrations on the accuracy of LDL-C(F) and LDL-C(M). Although LDL-C levels showed a positive correlation with TG levels, the LDL-C(F) levels tended to show a greater divergence from LDL-C(D) levels than that shown by LDL-C(M) with changes in TG levels.Conclusion: We for the first time demonstrated a more useful measurement of LDL-C levels estimated by Martin's method than that estimated by the Friedewald equation in Japanese patients with DM.